Provider Demographics
NPI:1841355351
Name:SWAIM, AMY L (LCSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:SWAIM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 WINDING OAK WAY
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27520-7129
Mailing Address - Country:US
Mailing Address - Phone:919-830-2072
Mailing Address - Fax:
Practice Address - Street 1:5613 DURALEIGH RD
Practice Address - Street 2:SUITE 161
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27612-2694
Practice Address - Country:US
Practice Address - Phone:919-830-2072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-26
Last Update Date:2012-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0041301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC131EXOtherBCBS PROVIDER NUMBER
NC6002437Medicaid
NC061677882OtherFEDERAL TAX